| NPI | 1205222940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: KY TP576) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 35.144970) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2025-08-02 |