| NPI | 1700993037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CA A40901) |
| Additional Taxonomies | 363LX0001X Nurse Practitioner, Obstetrics & Gynecology (Licence: CA NPF 8076) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2013-02-08 |