| NPI | 1750341574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: PA MD463843) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 0101267623) |
| 207V00000X Obstetrics & Gynecology (Licence: NY 229698) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2020-02-10 |