| NPI | 1215991856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NV 9105) |
| Additional Taxonomies | 207VF0040X Obstetrics & Gynecology Female Pelvic Medicine and Reconstructive Surgery (Licence: NV 9105) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2022-03-11 |