| NPI | 1972551638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: KY 32782) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 35052398F) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2021-03-15 |