| NPI | 1215195144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: OH 34.010049) |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2021-10-28 |