| NPI | 1629496922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: MI 4301115453) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WI 65222) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2024-02-28 |