| NPI | 1427246776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME162762) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PR 17318) |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2023-06-20 |