| NPI | 1417213596 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207VM0101X Obstetrics & Gynecology, Maternal & Fetal Medicine (Licence: FL OS16190) | 
| Additional Taxonomies | 207VM0101X Obstetrics & Gynecology, Maternal & Fetal Medicine (Licence: PA OS018252) | 
| Enumeration Date | 2012-04-03 | 
| Last Update Date | 2025-08-19 |