| NPI | 1659825164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NY 316689) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PR 35710) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-08-12 |
| Last Update Date | 2024-02-13 |