| NPI | 1760793657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: KY 57929) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX Q0542) |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2024-12-09 |