| NPI | 1710293048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NY 257837) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 257837) |
| Enumeration Date | 2010-08-24 |
| Last Update Date | 2014-10-14 |