| NPI | 1124192489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MB06991400) |
| Additional Taxonomies | 208800000X Urology (Licence: TX M0022) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2022-03-07 |