| NPI | 1043502800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX Q5598) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA OT014145) |
| Enumeration Date | 2011-05-11 |
| Last Update Date | 2020-10-16 |