| NPI | 1104259548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME158618) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: ID 5171975) |
| Enumeration Date | 2013-08-20 |
| Last Update Date | 2025-09-03 |