| NPI | 1588747026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: VA 0101240548) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: VA 0101240548) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2016-09-30 |