| NPI | 1043223696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WY 8335A) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WA OP00001719) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2023-02-08 |