| NPI | 1093208134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: ID O-1672) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OR DO219324) |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2026-06-23 |