| NPI | 1487151205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology Female Pelvic Medicine and Reconstructive Surgery (Licence: TX U1488) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 4351028121) |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2023-02-14 |