| NPI | 1467451906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WA MD60096557) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MO MD114350) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2021-05-03 |