| NPI | 1609131606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NE 33280) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: IA MD-47431) |
| 207V00000X Obstetrics & Gynecology (Licence: CA A147725) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301101124) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA MD-47431) | |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2021-09-22 |