| NPI | 1417335050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MN 65868) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 57.026963) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-15 |
| Last Update Date | 2023-02-01 |