| NPI | 1194213793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NC 2022-01750) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WA MD61424267) |
| Enumeration Date | 2018-04-29 |
| Last Update Date | 2024-03-13 |