| NPI | 1093105173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: MI 4301510336) |
| Additional Taxonomies | 208800000X Urology (Licence: NJ 25MA11174700) |
| Enumeration Date | 2015-01-28 |
| Last Update Date | 2026-07-19 |