| NPI | 1083875710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: WV 26934) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: FL ME116789) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2016-09-07 |