| NPI | 1376512657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME64382) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 35-091782) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2021-06-22 |