| NPI | 1912079401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX F8356) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OR MD42442) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2020-11-03 |