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 |