| NPI | 1316947997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MA10291400) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MD051265L) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2018-05-15 |