| NPI | 1619931797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME89421) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: LA 024409) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2011-04-19 |