| NPI | 1770657587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: VA 0101269563) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA MD430316) |
| 207V00000X Obstetrics & Gynecology (Licence: NY 263045) | |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2021-11-05 |