| NPI | 1811973944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MO 33207) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 33207) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2012-08-29 |