| NPI | 1982700969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 5298) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CA 20A5298) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2025-10-22 |