| NPI | 1831185354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: VA 0101040957) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: DC MD12475) |
| 208D00000X General Practice (Licence: VA 0101040957) | |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2013-02-19 |