| NPI | 1417060328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: AZ 11281097) |
| Additional Taxonomies | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: MT 6594) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2025-10-30 |