| NPI | 1720062292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME49392) |
| Additional Taxonomies | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: FL ME49392) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2007-07-08 |