| NPI | 1174514020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME 40218) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 0101232643) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2022-09-23 |