| NPI | 1518278340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MO 2013039277) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NE 27763) |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2015-09-01 |