| NPI | 1124549233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MA12510800) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MD490920) |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2026-05-06 |