| NPI | 1508159641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME119486) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: KY 45070) |
| Enumeration Date | 2011-05-23 |
| Last Update Date | 2022-05-10 |