| NPI | 1770520728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WA MD60474298) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MA 77903) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2021-12-14 |