| NPI | 1578884128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NY 286840) |
| Additional Taxonomies | 208800000X Urology (Licence: TX Q3387) |
| 208800000X Urology (Licence: CA A112522) | |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2018-03-17 |