| NPI | 1912471749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NY 343900) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 343900) |
| Enumeration Date | 2019-01-15 |
| Last Update Date | 2024-12-03 |