| NPI | 1528306388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: CA 20a22923) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 20a22923) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-01-29 |
| Last Update Date | 2025-07-30 |