| NPI | 1023376969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NY 300538) |
| Additional Taxonomies | 208800000X Urology (Licence: NJ 25MA10366900) |
| 208800000X Urology (Licence: CT 69557) | |
| Enumeration Date | 2012-04-29 |
| Last Update Date | 2023-06-22 |