| NPI | 1346701190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CA 207120) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WA MD61403158) |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2026-08-04 |