| NPI | 1770693251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: UT 347528-1205) |
| Additional Taxonomies | 174400000X Specialist (Licence: UT 347528-1205) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2024-05-08 |