| NPI | 1609827336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: CA 20A8878) |
| Additional Taxonomies | 208800000X Urology (Licence: NJ 25MB07385700) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2022-03-28 |