| NPI | 1710102785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME15344) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CA G17485) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2007-07-08 |