| NPI | 1417965146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NY 140064) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 140064) |
| 208D00000X General Practice (Licence: CA C145147) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2022-11-22 |