| NPI | 1588153043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME157910) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX BP10064219) |
| Enumeration Date | 2018-05-09 |
| Last Update Date | 2022-11-03 |