| NPI | 1295178580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME140756) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MS 24652) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL MD.34009) | |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2021-11-10 |