| NPI | 1235428707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WA MD61032559) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AK 100642) |
| Enumeration Date | 2011-04-05 |
| Last Update Date | 2020-07-14 |