| NPI | 1992187256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: NV DO2715) |
| Additional Taxonomies | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: TX U8317) |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2023-12-27 |