| NPI | 1831570738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CT 69437) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 299159) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2021-11-09 |