| NPI | 1306893987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME157347) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: AL 24525) |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2022-08-17 |