| NPI | 1366519167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: FL ME57803) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2013-10-08 |