| NPI | 1700855962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: LA MD021377) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: LA MD021377) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2008-05-01 |