| NPI | 1881123842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX T7173) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NE 33411) |
| 207V00000X Obstetrics & Gynecology (Licence: OK 33049) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2022-06-05 |