| NPI | 1306912746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2088P0231X Urology, Pediatric Urology (Licence: FL ME177148) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 216290) |
| 208800000X Urology (Licence: PA MD431027) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2026-01-12 |