| NPI | 1740560812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: GA 77619) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: RI MD13764) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-08-22 |
| Last Update Date | 2023-03-08 |