| NPI | 1295739175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: NY 162749-1) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 162749-1) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2009-06-29 |