| NPI | 1902079858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: OH 35.138747) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 252434) |
| 207V00000X Obstetrics & Gynecology (Licence: NJ 25MA08842100) | |
| Enumeration Date | 2008-04-10 |
| Last Update Date | 2021-10-14 |