| NPI | 1629091913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME109905) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 240496) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2012-12-11 |