| NPI | 1093718397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NY 243259) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 35042288) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2018-10-10 |