| NPI | 1245261510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X Urology, Pediatric Urology (Licence: NC 2014-00521) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 100362) |
| 2088P0231X Urology, Pediatric Urology (Licence: FL ME135771) | |
| 2088P0231X Urology, Pediatric Urology (Licence: NH 20574) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2021-06-21 |