| NPI | 1265467989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 258103) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD071391L) |
| 207V00000X Obstetrics & Gynecology (Licence: PA MD071391L) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2010-11-15 |