| NPI | 1568824571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: FL ME162878) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 4301502677) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2024-06-25 |