| NPI | 1144555475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NY 274320) |
| Additional Taxonomies | 208800000X Urology (Licence: NJ 25MA09021000) |
| Enumeration Date | 2009-10-05 |
| Last Update Date | 2016-09-25 |