| NPI | 1366656712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: PA MD440992) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 0101242423) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2013-08-14 |