| NPI | 1982095352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL Me 0037427) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 140158-1) |
| Enumeration Date | 2015-02-06 |
| Last Update Date | 2015-02-06 |