| NPI | 1063702702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: PA MD460767) |
| Additional Taxonomies | 208800000X Urology (Licence: NJ 25MA10273100) |
| Enumeration Date | 2011-04-14 |
| Last Update Date | 2020-02-05 |