| NPI | 1790180479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL 20083) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: NY 299257) |
| 207V00000X Obstetrics & Gynecology (Licence: CT 60560) | |
| Enumeration Date | 2014-10-24 |
| Last Update Date | 2026-01-27 |