| NPI | 1588076509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: KY 53946) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: KY TP271) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-25 |
| Last Update Date | 2020-06-15 |