| NPI | 1467452086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NY 122260) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 122260) |
| 363A00000X Physician Assistant (Licence: NY 122260) | |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2015-02-06 |