| NPI | 1881891240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MI 4301090776) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME169992) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2026-02-11 |