| NPI | 1295999308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NY 272042) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 010125) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2019-12-16 |