| NPI | 1780762252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MN 55550) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WI 48166-20) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2016-02-29 |