| NPI | 1639810757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: AZ 80716) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX 1528234911) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2026-08-06 |