| NPI | 1356775530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME134257) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PR 29562) |
| 208D00000X General Practice (Licence: PR 29562) | |
| Enumeration Date | 2013-08-24 |
| Last Update Date | 2018-05-22 |