| NPI | 1093788101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MA08256000) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MD070689-L) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2016-10-07 |