| NPI | 1134625361 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX T5280) | 
| Additional Taxonomies | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: TX T5280) | 
| Enumeration Date | 2018-04-05 | 
| Last Update Date | 2023-09-14 |