| NPI | 1629308994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: OR 7666) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OR MD07666) |
| Enumeration Date | 2010-01-07 |
| Last Update Date | 2010-01-07 |