| NPI | 1417979865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: VA 0101032522) |
| Additional Taxonomies | 173000000X Legal Medicine (Licence: VA 0101032522) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2017-10-17 |