| NPI | 1841449915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology Gynecologic Oncology (Licence: VA 0101256250) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 62604) |
| Enumeration Date | 2008-09-15 |
| Last Update Date | 2014-05-22 |