| NPI | 1265691505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CA A115961) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NJ 25MA09407100) |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2022-11-22 |