| NPI | 1467714576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NY 299768) |
| Additional Taxonomies | 208800000X Urology (Licence: FL TRN17321) |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2022-08-05 |