| NPI | 1104026210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: OH 35.122880) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 245150) |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2022-05-09 |