| NPI | 1871575696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology Gynecology (Licence: CT 22751) |
| Additional Taxonomies | 174400000X Specialist (Licence: CT 22751) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2011-09-14 |