| NPI | 1114085206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NY 132418-1) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CT 38719) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2019-03-27 |