| NPI | 1780697177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology Gynecology (Licence: OR MD11690) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology Gynecology (Licence: WA MD00034518) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2012-12-05 |