| NPI | 1053653204 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MI 4301103530) | 
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: FL 127814) | 
| Enumeration Date | 2013-03-25 | 
| Last Update Date | 2025-08-18 |