| NPI | 1982693123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME78151) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL MD.19935) |
| 207V00000X Obstetrics & Gynecology (Licence: FL 78151) | |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2021-06-22 |