| NPI | 1073752556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NJ 25MA08686200) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 255458) |
| Enumeration Date | 2009-02-06 |
| Last Update Date | 2023-03-07 |