| NPI | 1326120783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X Urology Pediatric Urology (Licence: FL ME140909) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 208263) |
| 2088P0231X Urology Pediatric Urology (Licence: NY 208263) | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2019-11-01 |