| NPI | 1578535092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX J2367) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: AR E2008) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2024-11-19 |