| NPI | 1124222674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NE 24080) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WA MD60518222) |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2024-06-20 |