| NPI | 1801850094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: GA 024255) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MN 76544) |
| 207Q00000X Family Medicine (Licence: GA 024255) | |
| 207V00000X Obstetrics & Gynecology (Licence: WA MD61650300) | |
| 207V00000X Obstetrics & Gynecology (Licence: KY C2486) | |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2025-09-29 |