| NPI | 1003070194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0000X Obstetrics & Gynecology Obstetrics (Licence: WV 24508) |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine (Licence: WV 24508) |
| 207V00000X Obstetrics & Gynecology (Licence: OH 35092078) | |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2018-03-17 |