| NPI | 1225291123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MA09795800) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MD451932) |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2022-08-25 |