| NPI | 1194728972 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207VM0101X Obstetrics & Gynecology, Maternal & Fetal Medicine (Licence: TX R9545) | 
| Additional Taxonomies | 207VM0101X Obstetrics & Gynecology, Maternal & Fetal Medicine (Licence: CA G37592) | 
| Enumeration Date | 2005-05-24 | 
| Last Update Date | 2020-09-04 |