| NPI | 1255331922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WA MD60209694) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 35060887) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2015-10-13 |