| NPI | 1710182779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology (Licence: CA 138819) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NC 2009-00884) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2025-11-04 |