| NPI | 1477558724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WI 22616) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NC 2008-01845) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2025-07-28 |