| NPI | 1376005975 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207VX0000X Obstetrics & Gynecology, Obstetrics (Licence: NC 2024-00046) | 
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program | 
| Enumeration Date | 2019-04-02 | 
| Last Update Date | 2024-01-16 |