| NPI | 1134184252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: MN 51151) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 49154) |
| 207V00000X Obstetrics & Gynecology (Licence: WI 1366-TEP) | |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2021-03-11 |