| NPI | 1477618122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME125439) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: AL 00025592) |
| Enumeration Date | 2006-12-23 |
| Last Update Date | 2015-12-04 |