| NPI | 1720196454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME18044) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL 54-2129332) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2020-03-16 |