| NPI | 1508951997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: CA C161770) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 25MA07045100) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2019-10-01 |