| NPI | 1285624478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: UT 56921151205) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: AZ 18853) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2025-10-15 |