| NPI | 1376595017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME125035) |
| Additional Taxonomies | 174400000X Specialist (Licence: AL 23970) |
| 207V00000X Obstetrics & Gynecology (Licence: CO DR.0065228) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2020-12-09 |