| NPI | 1922024256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME146435) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 35078532) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2021-08-17 |