| NPI | 1174846372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CT 082254) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OK 27569) |
| 207V00000X Obstetrics & Gynecology (Licence: WA 60406093) | |
| Enumeration Date | 2010-03-02 |
| Last Update Date | 2025-08-19 |