| NPI | 1528599511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WA MD61244542) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 0101271555) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2022-08-31 |