| NPI | 1417953597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME174917) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA 022661) |
| 207V00000X Obstetrics & Gynecology (Licence: LA 022661) | |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2025-10-30 |