| NPI | 1124201868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD009422E) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA MD009422E) |
| Enumeration Date | 2007-12-17 |
| Last Update Date | 2007-12-17 |