| NPI | 1659332765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: NY 203874-1) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: NY 203874-1) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2024-02-16 |