| NPI | 1053488353 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TN DO0000001147)  | 
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TN D0001147)  | 
| Enumeration Date | 2006-11-29 | 
| Last Update Date | 2015-08-14 |