| NPI | 1699882654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CO 45828) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NJ MA63268) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2021-06-18 |