| NPI | 1871615229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: TX Q2535) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: FL ME110669) |
| 207V00000X Obstetrics & Gynecology (Licence: CO 207V00000X) | |
| Enumeration Date | 2007-04-05 |
| Last Update Date | 2025-09-18 |