| NPI | 1194385617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: UT 6911175-1204) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 5101026544) |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2026-03-26 |