| NPI | 1174977524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MI 5101027078) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 34.014383) |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2022-12-01 |