| NPI | 1104819556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX M1837) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 34006576) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2014-02-19 |