| NPI | 1700447679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NC 263329) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NC 2024-02288) |
| 207Q00000X Family Medicine (Licence: PA OT019528) | |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2026-03-05 |