| NPI | 1295266369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: MO 2025033091) |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2025-09-02 |