| NPI | 1952368623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NY 159877) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VT 042-0011778) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2021-06-04 |