| NPI | 1477819647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: CA A127182) |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2025-09-15 |