| NPI | 1861468555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: FL ME112840) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 190448) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2019-12-04 |