| NPI | 1669506226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA C51512) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CA C51512) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2023-03-07 |