| NPI | 1821354424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WA MD61060910) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OR MD175268) |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2020-10-26 |