| NPI | 1356582977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX N9965) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX 42741 Temporary) |
| 207V00000X Obstetrics & Gynecology (Licence: TX 43203 Temporary Lic) | |
| Enumeration Date | 2009-03-11 |
| Last Update Date | 2012-10-22 |