| NPI | 1912997008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CA C162774) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX H1915) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2023-03-20 |