| NPI | 1740774173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: CA A177739) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: CA A177739) |
| 207V00000X Obstetrics & Gynecology (Licence: MI 4301114559) | |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2022-12-02 |