| NPI | 1881689164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: PR 4383) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 4383) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2012-06-14 |