| NPI | 1710407515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: VA 0101275934) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA MD474645) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT214211) | |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2022-09-29 |