| NPI | 1629455670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Female Pelvic Medicine and Reconstructive Surgery (Licence: NY 298194) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: NY 298194) |
| 363AM0700X Physician Assistant, Medical (Licence: NY 298194) | |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2023-07-22 |