| NPI | 1790920510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: OR MD218115) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WA MD60015282) |
| Enumeration Date | 2008-12-08 |
| Last Update Date | 2026-06-11 |