| NPI | 1871688101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: FL ME100320) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NJ MA71071) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2010-07-02 |