| NPI | 1104810605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME162462) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MS 18575) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2024-01-19 |