| NPI | 1063808988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NC 2020-00478) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: SC 82093) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2020-03-20 |