| NPI | 1720198880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: LA 311933) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WI 39972-20) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2026-02-20 |