| NPI | 1548680994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NC 2018-01005) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 0101279159) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2026-05-01 |