| NPI | 1306879333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CO CDRH.0041642) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WI 13011) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2025-12-16 |