| NPI | 1801022926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CA A120023) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 268670) |
| Enumeration Date | 2009-06-03 |
| Last Update Date | 2021-11-18 |