| NPI | 1962822650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VX0201X Obstetrics & Gynecology, Gynecologic Oncology (Licence: TX R6288) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL S520-8188-8270) |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2021-04-13 |