| NPI | 1255496568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MN 54800) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX K5477) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2020-09-17 |