NPI | 1639441801 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 261Q00000X Clinic/Center (Licence: NY 136893-1) |
Additional Taxonomies | 2088P0231X Urology, Pediatric Urology (Licence: NY 136893-1) |
Enumeration Date | 2012-02-03 |
Last Update Date | 2012-02-03 |