| NPI | 1073707618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME107279) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL TRN10099) |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2022-01-27 |