| NPI | 1710399563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NC 2019-01942) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: TN 57418) |
| 207V00000X Obstetrics & Gynecology (Licence: GA 79822) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2022-12-22 |