| NPI | 1811166655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CA A101561) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NC 2026-02749) |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2026-06-17 |