| NPI | 1760475164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MO 110977) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA MD057842L) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2016-07-01 |