| NPI | 1609834068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: SC 8893) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 8893) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2009-12-30 |