| NPI | 1356877161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: VA 0101266108) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: VA 0101266108) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2025-08-05 |