| NPI | 1700077021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME 102221) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PR 26185) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2012-12-19 |