| NPI | 1346634433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NY 297659-1) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 35.129902) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2020-02-21 |