| NPI | 1396765376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 1869681205) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 186968-1205) |
| 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: UT 1869681205) | |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2024-05-20 |