| NPI | 1013153782 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207VE0102X Obstetrics & Gynecology, Reproductive Endocrinology (Licence: NY 172112)  | 
| Additional Taxonomies | 207VE0102X Obstetrics & Gynecology, Reproductive Endocrinology (Licence: MA 72477)  | 
| 207VE0102X Obstetrics & Gynecology, Reproductive Endocrinology (Licence: NJ MA58079)  | |
| Enumeration Date | 2008-12-30 | 
| Last Update Date | 2009-10-30 |