| NPI | 1942361548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G48383) |
| Additional Taxonomies | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: CA G48383) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2010-09-21 |