| NPI | 1588747026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0000X Obstetrics & Gynecology Obstetrics (Licence: VA 0101240548) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NC 2024-03566) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2025-04-14 |