| NPI | 1366202244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MN 80284) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MN 34290) |
| Enumeration Date | 2024-03-19 |
| Last Update Date | 2025-09-16 |