| NPI | 1063675056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CT 1.064736) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WA MD60339282) |
| 207V00000X Obstetrics & Gynecology (Licence: NY 003155) | |
| 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: TX T9742) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2022-09-08 |