| NPI | 1215227566 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207VM0101X Obstetrics & Gynecology, Maternal & Fetal Medicine (Licence: TX Q4196) | 
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX Q4196) | 
| Enumeration Date | 2011-04-07 | 
| Last Update Date | 2019-06-21 |