| NPI | 1124006838 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CA A66694)  | 
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NV 10674)  | 
| Enumeration Date | 2006-01-03 | 
| Last Update Date | 2023-11-02 |