| NPI | 1083776868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: LA 018221) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MS 30034) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2026-02-03 |