| NPI | 1043517998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: TX Q0664) |
| Additional Taxonomies | 282NW0100X General Acute Care Hospital, Women (Licence: PR 12800-I) |
| Enumeration Date | 2011-02-11 |
| Last Update Date | 2020-02-04 |