| NPI | 1649276916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CO DR.0066994) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CA G72287) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2025-10-01 |