| NPI | 1952694747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology Gynecologic Oncology (Licence: PA OS017416) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 252192) |
| Enumeration Date | 2011-05-26 |
| Last Update Date | 2021-12-02 |