| NPI | 1912160763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX P3246) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NC 2019-02342) |
| 207V00000X Obstetrics & Gynecology (Licence: FL ME153082) | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2024-05-22 |