| NPI | 1679763155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: CT 048865) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 0101242733) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2022-09-28 |