| NPI | 1275283608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: OH 35.155253) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 4301512542) |
| Enumeration Date | 2022-03-28 |
| Last Update Date | 2026-06-19 |