| NPI | 1952305765 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: MI 43010363275) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 4301063275) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2022-07-21 |