| NPI | 1659772515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME146349) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PR 34043-R) |
| Enumeration Date | 2014-09-10 |
| Last Update Date | 2020-10-12 |