| NPI | 1063515096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: OR MD 11821) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WA MD 00034562) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2007-07-08 |