| NPI | 1356478663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WV 22915) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: FL ME172604) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2026-04-15 |