| NPI | 1669811667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WA 60759717) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 0116026327) |
| 207V00000X Obstetrics & Gynecology (Licence: FL ME175852) | |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2025-09-10 |