| NPI | 1881751071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WA MD61263174) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OR MD175483) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2026-02-03 |