| NPI | 1194152348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NJ 25MA12806400) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 303154) |
| Enumeration Date | 2013-10-02 |
| Last Update Date | 2025-10-06 |