| NPI | 1063487601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: FL ME156793) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: SC 82021) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2025-02-25 |