| NPI | 1811208770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WY 10921A) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: FL ME 124962) |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2019-06-08 |