| NPI | 1770572232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX R7102) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 1433551) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2020-11-12 |