| NPI | 1780726299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX H3059) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: ME MD29075) |
| 207V00000X Obstetrics & Gynecology (Licence: WI 101522) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2025-01-14 |