| NPI | 1861050288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WI 8413020) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: PA MD481458) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT218573) | |
| Enumeration Date | 2019-05-31 |
| Last Update Date | 2024-07-24 |