| NPI | 1295794642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MA07964400) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 21555) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2011-11-09 |