| NPI | 1528357274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: WA MD00019077) |
| Additional Taxonomies | 208800000X Urology (Licence: FL ME109456) |
| 208800000X Urology (Licence: PA MD450852) | |
| 208800000X Urology (Licence: NY 269807) | |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2023-01-04 |