| NPI | 1396936571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WA MD60298859) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: ND 12121) |
| 207V00000X Obstetrics & Gynecology (Licence: TX P0366) | |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2016-10-05 |