| NPI | 1407471436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MI 4351046122) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: RI MD19795) |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2026-05-29 |