| NPI | 1962997353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: NJ 25MB11370800) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101024090) |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2022-07-26 |