| NPI | 1417198003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: NY 163558) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 163558) |
| 208D00000X General Practice (Licence: NY 163558) | |
| Enumeration Date | 2009-03-12 |
| Last Update Date | 2013-02-26 |