| NPI | 1073873931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: FL ME129895) |
| Enumeration Date | 2012-05-24 |
| Last Update Date | 2026-04-08 |