| NPI | 1235634163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NE 32957) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 57.245682) |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2023-08-24 |