| NPI | 1861494197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 202K00000X (Licence: AZ 21176) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: AZ 21176) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2013-08-31 |