| NPI | 1487673695 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX G0966) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: TX G0966) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2019-08-16 |