| NPI | 1093372823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WA MD70031782) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: SC 90597) |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2025-11-18 |