| NPI | 1932587730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX S1053) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OK 5946) |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2019-06-20 |