| NPI | 1619132446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: SC 84896) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 004073) |
| 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: NY 268553) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-07-21 |
| Last Update Date | 2020-10-27 |