| NPI | 1962457663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MT 7259) |
| Additional Taxonomies | 174400000X Specialist (Licence: MT 7259) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2018-04-18 |