| NPI | 1679729297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NY 269601) |
| Additional Taxonomies | 208800000X Urology (Licence: TX P2564) |
| 208800000X Urology (Licence: IL 125050763) | |
| Enumeration Date | 2008-08-14 |
| Last Update Date | 2023-03-23 |