| NPI | 1194012732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME132857) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 4301099314) |
| Enumeration Date | 2011-07-04 |
| Last Update Date | 2021-08-05 |