| NPI | 1235423138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL 109718) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 262606) |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2022-02-07 |