| NPI | 1225123409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VX0000X Obstetrics & Gynecology Obstetrics (Licence: NY 312606) |
| Additional Taxonomies | 207VX0000X Obstetrics & Gynecology Obstetrics (Licence: NM MD2004-0323) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2021-09-01 |