| NPI | 1649447897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NY 292891) |
| Additional Taxonomies | 208800000X Urology (Licence: MN 61626) |
| 208800000X Urology (Licence: SC 51223) | |
| 208800000X Urology (Licence: FL ME110108) | |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2024-03-04 |