| NPI | 1043216542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: UT 8363008-1204) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MO 11372) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2023-01-05 |