| NPI | 1285747873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WA OP 60104325) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 5101017577) |
| 207V00000X Obstetrics & Gynecology (Licence: MS 19319) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2022-09-23 |