NPI | 1558719658 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: TX S4441) |
Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: TX S4441) |
Enumeration Date | 2016-05-30 |
Last Update Date | 2025-09-25 |