| NPI | 1689604993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: ID M4237) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WA MD00037242) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2012-07-20 |