| NPI | 1528249885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G79925) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: CA G79925) |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2013-08-20 |