| NPI | 1689931933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX R0360) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WA OP60816519) |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2021-07-29 |