| NPI | 1164412078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: OH 35.126642) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 4301064721) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2025-09-17 |