| NPI | 1386212058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: SD 17523) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA MT224119) |
| Enumeration Date | 2021-06-17 |
| Last Update Date | 2025-09-11 |