| NPI | 1609852300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WA MD61259693) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 0101102438) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2025-03-04 |