| NPI | 1013380609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME150252) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| 282NW0100X General Acute Care Hospital, Women | |
| Enumeration Date | 2015-11-04 |
| Last Update Date | 2021-04-30 |