| NPI | 1639168560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WI 68139) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL 0049037) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2025-11-18 |