| 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 | 2025-02-14 |