| NPI | 1760587117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WA MD00034939) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OR MD20592) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2022-02-04 |