| NPI | 1831176148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NY 206765) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CT 80278) |
| 207V00000X Obstetrics & Gynecology (Licence: MA 242431) | |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2025-07-02 |