| NPI | 1548907207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME155794) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: KY 59911) |
| Enumeration Date | 2022-05-15 |
| Last Update Date | 2025-09-17 |