| NPI | 1346372802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NY 302134) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: FL ME 100218) |
| Enumeration Date | 2007-03-11 |
| Last Update Date | 2022-08-18 |