| NPI | 1295744209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00036614) |
| Additional Taxonomies | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: WA MD00036614) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2011-12-04 |