| NPI | 1134522634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX T7491) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NJ 25MA10355800) |
| Enumeration Date | 2014-09-29 |
| Last Update Date | 2022-09-08 |