| NPI | 1114248697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME119928) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: GA 004345) |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2019-09-19 |