| NPI | 1316241656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: KY 42629) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 39844) |
| Enumeration Date | 2010-12-30 |
| Last Update Date | 2019-03-08 |