| NPI | 1952455594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MI 4301114799) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 35.084311) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2023-03-07 |