| NPI | 1265069132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MI 5101028105) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207V00000X Obstetrics & Gynecology (Licence: FL OS21179) | |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2024-08-29 |