| NPI | 1427150705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NY 217646-01) |
| Additional Taxonomies | 208800000X Urology (Licence: CT 70162) |
| 208800000X Urology (Licence: NY 217646) | |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2022-05-03 |