| NPI | 1528138294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0000X Obstetrics & Gynecology Obstetrics (Licence: CA A29978) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A29978) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2013-09-13 |