| NPI | 1174985931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: KY 56906) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology Gynecology (Licence: FL ME144031) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2022-07-11 |