| NPI | 1770582900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: PA MD036563L) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NJ 25MA03224200) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2007-07-08 |