| NPI | 1235394420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME147685) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 4301091720) |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2023-09-20 |