| NPI | 1710972641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: GA 54296) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: UT 7750270-1204) |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2025-12-04 |