| NPI | 1093009995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD450204) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA MD450204) |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2016-06-10 |