| NPI | 1265994172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NY 323946) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MA 1023915) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2026-06-16 |