| NPI | 1285160457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: MO 2021010145) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MO 2021010145) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2021-11-01 |