| NPI | 1689835738 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208800000X Urology (Licence: CA A109039) | 
| Additional Taxonomies | 208600000X Surgery (Licence: CA A109039) | 
| 208800000X Urology (Licence: NY 274598) | |
| Enumeration Date | 2008-06-21 | 
| Last Update Date | 2024-03-13 |