| NPI | 1457350795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NY 174810) |
| Additional Taxonomies | 202K00000X (Licence: NY 174810) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2017-04-27 |