| NPI | 1407960586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: VA 101034900) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: ME MD29997) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2026-02-17 |