| NPI | 1548252794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WA MD00017005) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA 17005) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2012-01-06 |