| NPI | 1801807755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WV 19734) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX V3276) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2026-01-05 |