| NPI | 1104869957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NY 190331-1) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 190331-1) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2011-01-14 |