| NPI | 1982999678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NY 300776) |
| Additional Taxonomies | 208800000X Urology (Licence: MA 269060) |
| 208800000X Urology (Licence: TX R2853) | |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2023-07-03 |