| NPI | 1922096627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NY 231029) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NY 231029) |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2017-04-21 |