| NPI | 1902815533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WV 21472) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA MD424185) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2020-12-01 |