| NPI | 1720669757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: OH 35.153412) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC OKOR-S3175H) |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2025-05-07 |