| NPI | 1003002072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MA09130400) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 221653) |
| Enumeration Date | 2007-09-24 |
| Last Update Date | 2012-09-12 |