| NPI | 1124082037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: WA MD00022396) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00022396) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2010-10-04 |