| NPI | 1518151158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX Q7139) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WA MD60302037) |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2020-01-31 |