| NPI | 1184679581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: FL ME153120) |
| Additional Taxonomies | 208800000X Urology (Licence: NJ 25MA07586500) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2022-04-11 |