| NPI | 1366839961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME162648) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NC 2016-01874) |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2023-11-16 |