| NPI | 1457411670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: PA md034805e) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA MD034805E) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2008-05-04 |