| NPI | 1730177882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: GA 17537) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: SC 8202) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2010-07-20 |