| NPI | 1023276748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX Q4383) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CA A120756) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN12323) | |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2018-05-21 |