| NPI | 1316987845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NY 184028) |
| Additional Taxonomies | 208800000X Urology (Licence: CA G078065) |
| 208800000X Urology (Licence: MA 78704) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2026-02-13 |