| NPI | 1396974598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NY 266819) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MD436105) |
| 208800000X Urology (Licence: FL ME 109677) | |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2013-10-15 |