| NPI | 1417163510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: OR MD207708) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WA MD60170823) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2023-08-02 |