| NPI | 1538187653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: NJ MA08630800) |
| Additional Taxonomies | 208800000X Urology (Licence: OH 35-056249) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2016-04-25 |