| NPI | 1114973708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: ID 5771332) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CA C54654) |
| 207V00000X Obstetrics & Gynecology (Licence: AK MEDS5236) | |
| 207V00000X Obstetrics & Gynecology (Licence: UT 6626848-1205) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2025-07-01 |