| NPI | 1558420968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MN 52646) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX K3108) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2020-08-12 |