| NPI | 1215084603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX Q7723) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0101241008) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2024-12-02 |