| NPI | 1023094976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NC 2026-00390) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 0101231155) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2026-02-09 |