| NPI | 1912535949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME167942) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NC 261085) |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2024-09-03 |