| NPI | 1083027916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NJ 25ma10942600) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 313023-01) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2023-03-07 |