| NPI | 1942385091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX G5702) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WA MD61508942) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2024-01-19 |