| NPI | 1750611190 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: SC 93954) | 
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: FL OS18219) | 
| 207V00000X Obstetrics & Gynecology (Licence: NY 268557) | |
| Enumeration Date | 2010-01-07 | 
| Last Update Date | 2025-08-07 |