| NPI | 1508155268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology Female Pelvic Medicine and Reconstructive Surgery (Licence: GA GA72427) |
| Additional Taxonomies | 207VG0400X Obstetrics & Gynecology Gynecology (Licence: TN MD0000046779) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2019-11-13 |