| NPI | 1255534285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: TX M4627) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX M4627) |
| 207V00000X Obstetrics & Gynecology (Licence: TX M4627) | |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2017-01-20 |