| NPI | 1558365510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX E8860) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: TX E8860) |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2015-09-03 |