| NPI | 1518913680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00026594) |
| Additional Taxonomies | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: WA MD00026594) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2007-08-21 |