| NPI | 1215374905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60572273) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA ML 60370992) |
| 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: WA MD60572273) | |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2019-03-12 |