| NPI | 1265481733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME138871) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: FL ACN1024) |
| 207V00000X Obstetrics & Gynecology (Licence: PR 12056) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2019-10-07 |