| NPI | 1144223272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CA C158387) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WY TL2023) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2019-09-17 |