| NPI | 1770675092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WA MD60844955) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: AL 28952) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2021-02-02 |