| NPI | 1861616047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX L4123) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX L4123) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2025-01-15 |