| NPI | 1659865913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CA A180304) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX BP10063412) |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2026-04-14 |