| NPI | 1659359040 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207VE0102X Obstetrics & Gynecology, Reproductive Endocrinology (Licence: NC 2018-0147) | 
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: SC 52044) | 
| 207V00000X Obstetrics & Gynecology (Licence: NC 2018-01047) | |
| Enumeration Date | 2006-01-05 | 
| Last Update Date | 2022-08-23 |