| NPI | 1689826125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: GA 80714) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: GA 80714) |
| 207V00000X Obstetrics & Gynecology (Licence: PA OS016606) | |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2019-10-29 |