| NPI | 1164620696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME131178) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 35.122102) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2022-01-28 |