| NPI | 1457511925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME115433) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 246730-1) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2021-03-31 |