| NPI | 1457022766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NY 311370) |
| Additional Taxonomies | 208800000X Urology (Licence: PA LT000895) |
| Enumeration Date | 2021-09-26 |
| Last Update Date | 2021-09-26 |