| NPI | 1396094744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: GA 076530) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 35.121625) |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2016-09-13 |