| NPI | 1124008172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME102731) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NJ 25MA07549400) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2023-11-22 |