| NPI | 1770841561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: FL ME168693) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: OH 35.128704) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 63227) | |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2024-09-19 |