| NPI | 1568455004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX H8915) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OK 24834) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2014-03-11 |