| NPI | 1154304228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MA 246567) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 307586) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2021-03-12 |