| NPI | 1649383480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WA MD00042096) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OR MD24463) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2021-05-18 |