| NPI | 1063771079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: NC 2015-01378) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NJ 25mb09094400) |
| Enumeration Date | 2012-05-10 |
| Last Update Date | 2022-04-25 |