| NPI | 1104263441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: PA MT204569) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: ME MD21738) |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2018-09-20 |