| NPI | 1750636452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CA A127270) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX R5564) |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2025-06-12 |