| NPI | 1255442653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX P2547) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX P2547) |
| 174400000X Specialist (Licence: VA 0101237819) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2026-07-08 |