| NPI | 1114925401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MA 158781) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX K9137) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2025-03-25 |