| NPI | 1376830976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME157693) |
| Additional Taxonomies | 208800000X Urology (Licence: CA C187202) |
| 208800000X Urology (Licence: NY 276506) | |
| 208800000X Urology (Licence: MA 263208) | |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2025-06-03 |