| NPI | 1265547103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME45241) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CA G140070) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2026-07-01 |