| NPI | 1609282938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX V6891) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: GA 91972) |
| 207V00000X Obstetrics & Gynecology (Licence: NY 2928551) | |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2026-09-01 |