| NPI | 1619219052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: VA 0101280217) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 297137) |
| 208800000X Urology (Licence: PA MD471068) | |
| Enumeration Date | 2013-03-24 |
| Last Update Date | 2024-04-25 |