| NPI | 1235493610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME172575) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 0101260124) |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2025-11-21 |