| NPI | 1568458032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: NY 124783) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NJ 25MA03604200) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2021-06-11 |