| NPI | 1538162615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WA MD00029864) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OR 12611) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2022-07-21 |