| NPI | 1396148573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NY 298225) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: GA 80556) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-10-02 |
| Last Update Date | 2019-06-07 |