| NPI | 1790980142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: FL ME120588) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 57.011526) |
| 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: NY 257005) | |
| Enumeration Date | 2007-06-17 |
| Last Update Date | 2025-12-30 |