| NPI | 1205010642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NY 267326) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NH 20844) |
| 207V00000X Obstetrics & Gynecology (Licence: VT 042-0011901) | |
| 207V00000X Obstetrics & Gynecology (Licence: ND 12407) | |
| Enumeration Date | 2007-12-20 |
| Last Update Date | 2022-01-11 |