| NPI | 1003892480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: UT 7293324-1205) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WA MD61187434) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2021-06-21 |