| NPI | 1265582134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME98028) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: LA 011875) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2016-03-28 |