| NPI | 1750417788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: OH 35-05-5785-J) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: IA 36853) |
| 207V00000X Obstetrics & Gynecology (Licence: WY TL783) | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2008-08-13 |