| NPI | 1487917787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WY 12905A) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: FL ME138575) |
| 207V00000X Obstetrics & Gynecology (Licence: WY TL6260) | |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2020-08-26 |