| NPI | 1669639779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: OH 34.009883) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 58.002153) |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2021-01-27 |