| NPI | 1861533572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NY 250730) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY P42440) |
| 207V00000X Obstetrics & Gynecology (Licence: FL ME105457) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2023-02-23 |