| NPI | 1265403463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: UT 10718410-1205) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NC 200101151) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2020-05-06 |