| NPI | 1023109451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NJ 25MA06177500) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 246971) |
| 207V00000X Obstetrics & Gynecology (Licence: NJ MA61775) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2021-03-31 |