| NPI | 1235558479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MA40095500) |
| Additional Taxonomies | 208800000X Urology (Licence: CA 128194) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2022-03-09 |