| NPI | 1629055280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME107706) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CA G87312) |
| 207V00000X Obstetrics & Gynecology (Licence: NY 147498) | |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2022-07-21 |