| NPI | 1265476253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX M3753) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX TEMP) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2013-04-25 |