| NPI | 1255872446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CT 077278) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 35.142174) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2024-09-23 |