| NPI | 1912293010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MO 2015012713) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MO 2011019436) |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2015-06-24 |