| NPI | 1477571461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MI 37010) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 037010) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2012-04-03 |