| NPI | 1629505623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: VA 0101265505) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101265505) |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2025-10-07 |