| NPI | 1255319828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: GA 85640) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NC 200200772) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2025-01-22 |