| NPI | 1134650138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MA 1014180) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WA MD61138879) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2023-08-01 |