| NPI | 1568492759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CA A93435) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 25MAO7821200) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2022-01-31 |