| NPI | 1386836401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology Gynecologic Oncology (Licence: WV 25793) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA MT191194) |
| 207VX0201X Obstetrics & Gynecology Gynecologic Oncology (Licence: FL ME109243) | |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2021-12-06 |