| NPI | 1558339721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: SC 11090) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 0101256714) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2018-12-19 |