| NPI | 1508832973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NJ MA06445800) |
| Additional Taxonomies | 208800000X Urology (Licence: PA MD031083E) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2016-03-24 |