| NPI | 1356449052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WA MD00022812) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OR 23785) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2022-07-21 |