| NPI | 1811107279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: OH 35.091423) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 57.008338) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2021-09-30 |