| NPI | 1043441751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME118921) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 4301094026) |
| Enumeration Date | 2009-07-29 |
| Last Update Date | 2014-08-11 |