| NPI | 1073671673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: WV 16950) |
| Additional Taxonomies | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: KY 31309) |
| 207V00000X Obstetrics & Gynecology (Licence: KY 31309) | |
| 207V00000X Obstetrics & Gynecology (Licence: WV 16950) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2022-04-26 |