| NPI | 1225599327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CA A202164) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: UT 13423486-1205) |
| 2084A0401X Psychiatry & Neurology Addiction Medicine (Licence: UT 13423486-1205) | |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2025-04-22 |