| NPI | 1215464391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: UT 14228406-1205) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: AZ 63709) |
| Enumeration Date | 2017-05-19 |
| Last Update Date | 2025-12-01 |