| NPI | 1316916695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NC 2025-00262) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 0101239679) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2025-10-09 |