| NPI | 1619954658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MA 52996) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NY 308942) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2023-07-17 |