| NPI | 1811997703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: TX G5924) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: AR R3309) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2007-07-14 |