| NPI | 1154511012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MA08723000) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 243512) |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2010-07-10 |