| NPI | 1427168764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: SD LT1049) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD036379E) |
| 207V00000X Obstetrics & Gynecology (Licence: PA MD036379E) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2010-06-01 |