| NPI | 1578183711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME167295) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 39) |
| Enumeration Date | 2020-04-17 |
| Last Update Date | 2024-07-03 |