| NPI | 1982134367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: WI 70456-21) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WI 70456-21) |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2024-06-07 |