| NPI | 1073263992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CA 208879) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WI Student) |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2026-05-05 |