| NPI | 1639397359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology Gynecology (Licence: KY TP285) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology Gynecology (Licence: WA MD00048039) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2016-08-18 |