| NPI | 1386646107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX H0020) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 135371) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2014-05-22 |