| NPI | 1518587294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NY 303792) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 303792) |
| Enumeration Date | 2020-04-22 |
| Last Update Date | 2023-07-07 |