| NPI | 1295718138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: MI 4301046890) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2015-10-07 |