| NPI | 1902881980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX E0376) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX E0376) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2007-12-03 |