| NPI | 1679550529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: MN 47126) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MN 47126) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2020-08-21 |