| NPI | 1750643193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: UT 14015632-1204) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NE 1429) |
| 207V00000X Obstetrics & Gynecology (Licence: TX BP10044115) | |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2026-06-17 |