| NPI | 1659352722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NC 9800164) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: SC 336) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2025-12-29 |