| NPI | 1265471536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X (Licence: FL ME128200) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 166646) |
| 2088P0231X (Licence: NY 166646) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2018-03-17 |