| NPI | 1174817118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Female Pelvic Medicine and Reconstructive Surgery (Licence: WA OP60961030) |
| Additional Taxonomies | 207VF0040X Obstetrics & Gynecology, Female Pelvic Medicine and Reconstructive Surgery (Licence: NJ 25MB09714700) |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2024-05-13 |