| NPI | 1942542782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: WI 70608) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NY 282941) |
| Enumeration Date | 2013-03-19 |
| Last Update Date | 2023-07-07 |