| NPI | 1114913407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME123097) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 234914-1) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2023-08-28 |