| NPI | 1376920165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NY 300002) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NJ 25MB11339800) |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2024-08-22 |