| NPI | 1730395179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MO 2010013493) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 58002300) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2018-11-14 |