| NPI | 1720342900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME146669) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: GA 077782) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2021-12-09 |