| NPI | 1972605293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WA MD00033331) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MN 42504) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2014-02-17 |