| NPI | 1447366141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX M9759) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: FL ME0062903) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2019-05-20 |