| NPI | 1477650935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A36946) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: CA A36946) |
| Enumeration Date | 2006-09-19 |
| Last Update Date | 2007-10-02 |