| NPI | 1578530408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CO CO24118) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: FL ME92330) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2013-04-09 |