| NPI | 1184990178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME140220) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WI 61546) |
| 207VG0400X Obstetrics & Gynecology Gynecology (Licence: TN MD54321) | |
| Enumeration Date | 2012-03-24 |
| Last Update Date | 2023-07-19 |