| NPI | 1891182093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: UT 13398755-1205) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CA A163354) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-25 |
| Last Update Date | 2023-07-20 |