| NPI | 1629343215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G37501) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology Gynecology (Licence: CA G37501) |
| Enumeration Date | 2012-03-14 |
| Last Update Date | 2023-08-29 |