| NPI | 1962400465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX M0256) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX M0256) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2013-07-08 |