| NPI | 1699119396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME160128) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: KS 0439964) |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2023-07-14 |