| NPI | 1174586333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NJ 25MA06756400) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 196570) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2015-03-09 |