| NPI | 1295895316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NY 182316) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: FL ME108743) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2014-04-15 |