| NPI | 1508030958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: LA MD.205079) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: LA MD.205079) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2025-10-08 |