| NPI | 1346573912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME149431) |
| Additional Taxonomies | 2088P0231X Urology, Pediatric Urology (Licence: NY 219969) |
| 208800000X Urology (Licence: NY 219969) | |
| Enumeration Date | 2009-09-14 |
| Last Update Date | 2026-07-30 |