| NPI | 1205256047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: TX T3175) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: AL 37073) |
| Enumeration Date | 2014-04-20 |
| Last Update Date | 2022-11-09 |