| NPI | 1770961401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: SC 88440) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: RI MD16528) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 210432) | |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2024-09-18 |