| NPI | 1386607414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: OR MD08860) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WA MD00045703) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2007-07-08 |