| NPI | 1568494953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME151583) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TN MD38703) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2023-03-07 |