| NPI | 1720728165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 0102209768) |
| Enumeration Date | 2022-04-01 |
| Last Update Date | 2026-04-23 |