| NPI | 1619616836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NE 37487) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX BP10080715) |
| Enumeration Date | 2022-06-04 |
| Last Update Date | 2026-08-25 |