| NPI | 1609803006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX M4048) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 0101049545) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2008-07-24 |