| NPI | 1861496770 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX M6087) | 
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: LA 024745) | 
| Enumeration Date | 2005-06-08 | 
| Last Update Date | 2021-06-23 |