| NPI | 1215450739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CA 20553) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ND RL14673) |
| Enumeration Date | 2017-07-18 |
| Last Update Date | 2023-10-11 |