| NPI | 1538157029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NY 251966) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NJ 25MA06380200) |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2010-07-29 |