| NPI | 1912013624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: PR 007437) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX J7954) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2016-08-19 |