| NPI | 1891957940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: FL ME112645) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 4301093015) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2022-08-23 |