| NPI | 1013114545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology Gynecology (Licence: FL ME165361) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 271191) |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2024-02-09 |