| NPI | 1366734998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CA C172584) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: AZ 57583) |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2026-08-24 |