| NPI | 1104316777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: PA MD488714) |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2025-08-20 |