| NPI | 1629654744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MO 2025036258) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OK 7712) |
| Enumeration Date | 2021-03-19 |
| Last Update Date | 2025-08-27 |