| NPI | 1194229880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: KY 56235) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: FL TRN26827) |
| 207V00000X Obstetrics & Gynecology (Licence: FL ME144728) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2023-08-16 |