| NPI | 1740644145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2088P0231X (Licence: NY 328552) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MT210872) |
| 2088P0231X (Licence: DC MD210002642) | |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2025-02-17 |