| NPI | 1700144524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 71558) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA 60552997) |
| 207VX0000X Obstetrics & Gynecology Obstetrics (Licence: WA MD60552997) | |
| 208D00000X General Practice (Licence: WA 60552997) | |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2021-01-21 |