| NPI | 1952861668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WI 74811) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 0102207769) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2023-03-08 |