| NPI | 1104865294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: UT 14205551-1235) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA MD465915) |
| 207V00000X Obstetrics & Gynecology (Licence: NV 22549) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2026-05-13 |