| NPI | 1255712006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TN 6539) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 0102204634) |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2026-02-12 |