| NPI | 1902031073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NY 257204) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A107781) |
| Enumeration Date | 2009-05-19 |
| Last Update Date | 2023-05-08 |