| NPI | 1609866649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: CA A63365) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A63365) |
| 207V00000X Obstetrics & Gynecology (Licence: CA A63365) | |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2016-12-22 |