| NPI | 1588730840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MO 2010008611) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 0101242579) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2011-02-08 |