| NPI | 1720065253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: AZ 41204) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: GA 053918) |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2012-11-17 |