| NPI | 1336111814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WA MD60936474) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: HI MD 9544) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2020-12-02 |