| NPI | 1821069691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 55231-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD031976E) |
| 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: PA MD031976E) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2020-12-11 |