| NPI | 1972128445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX V2841) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: IL 125.076716) |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2024-08-06 |