| NPI | 1396852448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX g7137) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WI 25842020) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2019-02-20 |