| NPI | 1972644821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: UT 74303492-1205) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NM 2005-0325) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2021-06-08 |