| NPI | 1912385071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: TX R4013) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207V00000X Obstetrics & Gynecology (Licence: PA OS020106) | |
| Enumeration Date | 2015-05-09 |
| Last Update Date | 2023-07-12 |