| NPI | 1720461445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: MI 5101027142) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: KY TP553) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2022-11-11 |