| NPI | 1346669124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX R8996) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX BP10054932) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2023-05-08 |