| NPI | 1851384655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 117656) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 117656) |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2010-03-22 |