| NPI | 1699784652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CA 95051) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 240874) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2011-12-15 |