| NPI | 1366426652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NY 176263) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 176263) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2019-09-23 |