| NPI | 1114356599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: GA 081057) |
| Additional Taxonomies | 208800000X Urology (Licence: NJ 25MA10013800) |
| Enumeration Date | 2013-11-05 |
| Last Update Date | 2018-08-01 |