| NPI | 1215080007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: VA 0101241161) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 242483) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2018-09-04 |