| NPI | 1124149653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CA G33037) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology Gynecology (Licence: CA G33037) |
| 207VX0000X Obstetrics & Gynecology Obstetrics (Licence: CA G33037) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2012-11-09 |