| NPI | 1972634822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME100568) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 202729) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2026-01-23 |