| NPI | 1023269461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: CA A100044) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 260246-1) |
| Enumeration Date | 2008-10-03 |
| Last Update Date | 2021-11-04 |