| NPI | 1578895314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL 108827) |
| Additional Taxonomies | 2471S1302X Radiologic Technologist, Sonography (Licence: FL 93752) |
| Enumeration Date | 2010-02-04 |
| Last Update Date | 2012-02-07 |