| NPI | 1487654695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: IA 27220) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: IA 27220) |
| 207V00000X Obstetrics & Gynecology (Licence: NE 17301) | |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2016-10-25 |