| NPI | 1184659799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WA MD00018837) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MN 48062) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2015-02-03 |