| NPI | 1023090230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MA10611400) |
| Additional Taxonomies | 208800000X Urology (Licence: MI 4301086135) |
| 208800000X Urology (Licence: NJ BW9323382) | |
| 208800000X Urology (Licence: NY 240026) | |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2024-08-09 |