| NPI | 1912960006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MN 61281) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 333055) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2025-06-03 |