| NPI | 1730210444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WA OP00002222) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 5101015621) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2014-09-15 |