| NPI | 1912573411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: IA DO-06956) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IA R-12119) |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2025-07-07 |