| NPI | 1679888606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NY 271542) |
| Additional Taxonomies | 208800000X Urology (Licence: VA 0116021688) |
| 208800000X Urology (Licence: NY 003851) | |
| Enumeration Date | 2010-08-14 |
| Last Update Date | 2020-08-30 |