| NPI | 1598736555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME146327) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: FL ACN1057) |
| 207V00000X Obstetrics & Gynecology (Licence: PR 6554) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2020-09-17 |