| NPI | 1306377361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: ID 5861065) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 34.014064) |
| 207RA0401X Internal Medicine, Addiction Medicine (Licence: OH 34.014064) | |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2024-08-08 |