| NPI | 1164668570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX N9494) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX bpi0029009) |
| Enumeration Date | 2009-01-07 |
| Last Update Date | 2016-03-03 |