| NPI | 1902850290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: IA 27263) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: IL 036-084280) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2007-07-08 |