| NPI | 1285085480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: UT 11775524) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OT017448) |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2020-07-14 |