| NPI | 1679642649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: NY 179789) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 179789) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2007-07-08 |