| NPI | 1083242465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MA 1018992) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX 390200000X) |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2025-07-07 |