| NPI | 1225079064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX F3562) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: AR R3115) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2021-05-20 |