| NPI | 1073513495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX E4415) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: AR R2632) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2011-04-08 |