| NPI | 1255662284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MA08692300) |
| Additional Taxonomies | 208800000X Urology (Licence: AZ 78058) |
| Enumeration Date | 2010-01-14 |
| Last Update Date | 2025-10-20 |