| NPI | 1053350199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: FL 48138) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: FL 48138) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2020-02-24 |