| NPI | 1356487029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WA MD00019644) |
| Additional Taxonomies | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: WA MD00019644) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2016-07-17 |