| NPI | 1467833970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NY 305347) |
| Additional Taxonomies | 208800000X Urology (Licence: MA 282039) |
| 208600000X Surgery (Licence: MA L-263973) | |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2020-07-14 |