| NPI | 1154439909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: PA MD453476) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NJ 25MA06122800) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2015-04-15 |