| NPI | 1912299058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: MI 4301119123) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MO 2011014912) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-05-09 |
| Last Update Date | 2019-07-09 |