| NPI | 1295768406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: LA MD200946) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: FL ME175399) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2025-09-12 |