| NPI | 1174587562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LX0001X Nurse Practitioner, Obstetrics & Gynecology (Licence: CA G39916) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CA AN8786242) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2010-07-12 |