| NPI | 1376530675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX GO368) |
| Additional Taxonomies | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: PA MD458338) |
| Enumeration Date | 2005-10-02 |
| Last Update Date | 2020-12-23 |