| NPI | 1679568596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME145295) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 1773681) |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2020-12-03 |