| NPI | 1508066457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NM A-1560-10) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OK 0000) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2011-08-19 |