| NPI | 1053321737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX F6257) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NE 15006) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2012-04-05 |