| NPI | 1164721130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: GA 008721) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA 21687) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-03-16 |
| Last Update Date | 2018-08-08 |