| NPI | 1205836251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: MO 2018002920) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MO 2018002920) |
| 207V00000X Obstetrics & Gynecology (Licence: KS 04-41055) | |
| 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: KS 04-41055) | |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2018-09-26 |