| NPI | 1235663527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MA12094700) |
| Additional Taxonomies | 208800000X Urology (Licence: WI 81836) |
| 208800000X Urology (Licence: MN 73545) | |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2024-05-03 |