| NPI | 1578759627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NY 260994) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: CA A100077) |
| Enumeration Date | 2007-09-22 |
| Last Update Date | 2021-03-29 |