| NPI | 1821159856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX T2809) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 34.007114) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2021-09-13 |