| NPI | 1124185665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WA MD60315514) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WI 49864020) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2016-04-07 |