| NPI | 1588877674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 54939011205) |
| Additional Taxonomies | 207VX0000X Obstetrics & Gynecology Obstetrics (Licence: UT 54939011205) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2024-05-20 |