| NPI | 1063663615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: GA 70292) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: FL ME144816) |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2022-09-23 |