| NPI | 1952367963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 21135-01) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MA 81133) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2021-05-14 |