| NPI | 1083808513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX N7202) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OK 4719) |
| 207V00000X Obstetrics & Gynecology (Licence: TX N7202) | |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TX 4719) | |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TX N7202) | |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2024-05-02 |