| NPI | 1104903293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NY 216966) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: NY 216966) |
| 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: NY 216966) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2019-12-03 |