| NPI | 1073551800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NJ 25MA02915000) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ MA0291500) |
| 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: NJ 25MA02915000) | |
| 208600000X Surgery (Licence: FL ME119433) | |
| 208600000X Surgery (Licence: NY 125434) | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2015-09-28 |