| NPI | 1043549512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NJ 25MA10105500) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 253875-1) |
| 207V00000X Obstetrics & Gynecology (Licence: PA MD434757) | |
| Enumeration Date | 2009-12-13 |
| Last Update Date | 2022-08-16 |