| NPI | 1831124528 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA MD046771L) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA MD046771L) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2023-05-03 |