| NPI | 1982694600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NY 220260) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MA 82145) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2021-01-28 |