| NPI | 1235752478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MA12756500) |
| Additional Taxonomies | 208800000X Urology (Licence: RI LP04960) |
| Enumeration Date | 2020-05-22 |
| Last Update Date | 2025-06-23 |