| NPI | 1417277393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CA 13219) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: AZ R1781) |
| Enumeration Date | 2010-06-02 |
| Last Update Date | 2014-06-15 |