| NPI | 1255636981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: UT 183733-1205) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: OH 35.027196) |
| Enumeration Date | 2011-01-11 |
| Last Update Date | 2011-01-11 |