| NPI | 1063663771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME113197) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PR 17627) |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2020-07-30 |