| NPI | 1417110610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME113092) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MS T2101) |
| 207V00000X Obstetrics & Gynecology (Licence: MS 20800) | |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2023-06-21 |