| NPI | 1720143852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: FL ME126605) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 35-120960) |
| 207V00000X Obstetrics & Gynecology (Licence: PA MT187907) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2018-09-05 |