| NPI | 1023011673 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WV 19171) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 35075798M) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2024-10-16 |