| NPI | 1598767725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME130426) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WY 13196A) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2021-04-12 |