| NPI | 1063488617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: TX N2629) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: FL ME93500) |
| 207V00000X Obstetrics & Gynecology (Licence: TX N2629) | |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2011-07-07 |