| NPI | 1205254075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CT 64021) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 293023-1) |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2025-11-18 |