| NPI | 1528364957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX S3480) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NC 2021-00435) |
| 207V00000X Obstetrics & Gynecology (Licence: NY 280047-1) | |
| Enumeration Date | 2011-02-02 |
| Last Update Date | 2024-04-01 |