| NPI | 1912039306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: OH 35122083) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NC 2011-00144) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2019-06-28 |