| NPI | 1831478353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MI 5101022141) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CT CT State Permit) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-08-15 |
| Last Update Date | 2024-07-18 |