| NPI | 1255386322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: VA 0101051224) |
| Additional Taxonomies | 174400000X Specialist |
| 174400000X Specialist (Licence: NY 183778) | |
| 207V00000X Obstetrics & Gynecology (Licence: WV 19349) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2020-03-19 |