| NPI | 1174018212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NJ 25MB11346300) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA OS024298) |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2024-11-06 |