| NPI | 1093237521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME155686) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 33287) |
| Enumeration Date | 2017-07-17 |
| Last Update Date | 2022-08-19 |