| NPI | 1871681742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology Gynecology (Licence: ND 4177) |
| Additional Taxonomies | 207VX0000X Obstetrics & Gynecology Obstetrics (Licence: ND 4177) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2014-12-04 |