| NPI | 1548380538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: VA 101-229802 va) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 082082) |
| Enumeration Date | 2007-03-31 |
| Last Update Date | 2016-01-25 |