| NPI | 1881605897 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: PA MD059676L)  | 
| Enumeration Date | 2006-08-11 | 
| Last Update Date | 2014-11-05 |