| NPI | 1619267655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NY 287233) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WI 69250-20) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2022-10-25 |