| NPI | 1477689834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00024811) |
| Additional Taxonomies | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: WA MD00024811) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2013-05-09 |