| NPI | 1891785796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NY 169529-1) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 169529) |
| 207V00000X Obstetrics & Gynecology (Licence: VA 0101032481) | |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2016-12-14 |