| NPI | 1114922911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: KY 34447) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 35. 073600) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2023-04-27 |