| NPI | 1154499945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA C23746) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CA C23746) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2007-12-05 |