| NPI | 1962889212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: VA 0102207833) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 285506-01) |
| Enumeration Date | 2015-05-06 |
| Last Update Date | 2023-07-19 |