| NPI | 1215515390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: VA 0101275807) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CT 84044) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-31 |
| Last Update Date | 2026-07-13 |