| NPI | 1861654725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME150808) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 212033) |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2023-07-27 |