| NPI | 1790794568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: UT 5295480-1205) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: UT 52954801205) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2021-11-17 |