| NPI | 1770548588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME135655) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX V8886) |
| 207V00000X Obstetrics & Gynecology (Licence: GA 69132) | |
| 207V00000X Obstetrics & Gynecology (Licence: SC LL28109) | |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2026-08-06 |