| NPI | 1457324329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WY 6568A) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WI 76503) |
| 207V00000X Obstetrics & Gynecology (Licence: SD 4825) | |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2025-09-02 |