| NPI | 1023317500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME122662) |
| Additional Taxonomies | 282NW0100X General Acute Care Hospital, Women (Licence: MI 4301097961) |
| Enumeration Date | 2011-03-23 |
| Last Update Date | 2021-09-02 |