| NPI | 1366407819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME102966) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 0101233360) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2025-12-29 |