| NPI | 1083708747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME130127) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME130127) |
| 207QA0505X Family Medicine, Adult Medicine (Licence: FL ME130127) | |
| 207V00000X Obstetrics & Gynecology (Licence: AL 18239) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2022-09-20 |