| NPI | 1194738880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX N2352) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 5101011904) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2011-05-02 |