| NPI | 1932769502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MN 82501) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MO 2019018211) |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2026-08-20 |