| NPI | 1235493628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NV 16708) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WI 672-320) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2023-09-07 |