| NPI | 1366922387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.246256) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA MD4796000) |
| Enumeration Date | 2018-08-20 |
| Last Update Date | 2023-03-08 |