| NPI | 1972505907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: CO 37035) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CO CO37035) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2014-12-30 |