| NPI | 1992702641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: LA 07884R) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TX F0865) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2007-07-08 |