| NPI | 1285792879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: UT 8236288-1204) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA OS026290) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2026-08-13 |