| NPI | 1255378212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: TX Q6223) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MT 9786) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2023-07-11 |