| NPI | 1770576571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX U3763) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 5101016668) |
| 207V00000X Obstetrics & Gynecology (Licence: AZ 008805) | |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2023-07-05 |