| NPI | 1992817969 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: AZ 28840) | 
| Additional Taxonomies | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: AZ 28840) | 
| Enumeration Date | 2006-08-31 | 
| Last Update Date | 2014-03-18 |