| NPI | 1104486372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA HS000239L) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2021-03-29 |