| NPI | 1902996069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CA G84697) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NM MD2004-0169) |
| 207V00000X Obstetrics & Gynecology (Licence: CO DR.0065091) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2023-03-13 |