| NPI | 1417577339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NC 261399) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 261399) |
| Enumeration Date | 2020-04-21 |
| Last Update Date | 2023-12-05 |