| NPI | 1881658573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NC 22572) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 22572) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2011-12-06 |