| NPI | 1417216516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: UT 11745784-1205) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX R5855) |
| 207V00000X Obstetrics & Gynecology (Licence: PA MT201007) | |
| Enumeration Date | 2012-05-09 |
| Last Update Date | 2021-10-20 |