| NPI | 1710260963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX Q8128) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 28739-R) |
| Enumeration Date | 2011-09-23 |
| Last Update Date | 2024-06-07 |