| NPI | 1578723938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WI 50516) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA MD451121) |
| 207V00000X Obstetrics & Gynecology (Licence: MO 2009037642) | |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2019-10-08 |