| NPI | 1376625681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME 97208) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME97208) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2008-09-19 |