| NPI | 1063567634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX Q4370) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OK 23577) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2017-05-12 |