| NPI | 1174603500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX G3516) |
| Additional Taxonomies | 207VX0000X Obstetrics & Gynecology Obstetrics (Licence: TX G3516) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2019-03-12 |