| NPI | 1003295320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: TX R7717) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX 594025) |
| 208800000X Urology (Licence: NY 301446-01) | |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2022-12-29 |