| NPI | 1235690462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: KY 58288) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA MT217832) |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2024-05-24 |