| NPI | 1811995533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0000X Obstetrics & Gynecology Obstetrics (Licence: WY 3620A) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology Gynecology (Licence: WY 3620A) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2011-07-27 |