| NPI | 1548286594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME 108610) |
| Additional Taxonomies | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: NY 155813) |
| 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: KY 41981) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2012-01-04 |