| NPI | 1558657924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: NJ 25MB10148000) |
| Additional Taxonomies | 208800000X Urology (Licence: PA OT014010) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2017-11-22 |