| NPI | 1174750129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MA11983400) |
| Additional Taxonomies | 208800000X Urology (Licence: NY 273602) |
| 208800000X Urology (Licence: MI 4301109007) | |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2026-07-17 |