| NPI | 1558375733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NC 18948) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 18948) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2014-01-13 |