| NPI | 1235192543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL me115451) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 234811) |
| 207V00000X Obstetrics & Gynecology (Licence: NJ 25MA07862100) | |
| Enumeration Date | 2006-04-08 |
| Last Update Date | 2015-07-02 |