| NPI | 1649653924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX T1435) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: FL ME140538) |
| Enumeration Date | 2015-07-03 |
| Last Update Date | 2021-07-15 |