| NPI | 1750760187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: AZ 8486) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI In Progress) |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2025-11-20 |