| NPI | 1801881503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CA 20A9268) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A9268) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2010-07-12 |