| NPI | 1972036747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: TX T9280) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 314929) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207V00000X Obstetrics & Gynecology (Licence: NY 314929) | |
| Enumeration Date | 2017-04-07 |
| Last Update Date | 2023-07-17 |